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Kids’ menus have come a long way from the days when they were little more than sandwiches, soft drinks, and small fries for the small fries.

As parents increasingly seek out food that is healthful and nutritious for their children, particularly in light of America’s growing childhood-obesity crisis, restaurants have sought to provide menu items that are not only good for kids, but also taste great.

In fact, nutritionally balanced children’s dishes was the No. 4 trend on the National Restaurant Association’s annual survey of American Culinary Federation chefs for 2011, with children’s nutrition as an overall culinary theme coming in at No. 6 on the list.

Trends stemming originally from kids’ menus like gluten-free and allergy-consciousness ranked No. 8.

“There is increasing focus on the healthy aspects of children’s items, such as having milk instead of soft drinks and fruit and vegetables instead of fries,” says Sara Monnette, director of consumer research for Technomic Inc., the Chicago-based consulting firm.

“This is what parents are demanding,” she says. “They’re not always buying those items, but they want to see them available. It makes the restaurant a viable option.”

In fact, a recent survey by marketing website WhyMomsRule.com found that 70 percent of mothers demand the availability of healthy kids’ items on restaurant menus.

In addition to trends that deal with health and nutrition, restaurant analysts say value, including low-priced, discounted, or even free food for kids, has become the “new normal” for drawing financially strapped parents in this struggling economy.

An NPD Group study found traffic for visitors with children dropped 10 percent during the three years that ended in August 2010.

Healthful menu choices could have even more impact when national nutrition-disclosure rules go into effect for many chains. The law will require brands with at least 20 units to display the calories contained in regular menu items.

“Initially, there is going to be an impact in how well people become aware of calories in kids’ meals,” says Eric Giandelone, Chicago-based director of foodservice research at Mintel International, a global market research firm.

“We anticipate there will be a short-term shift in what parents will be ordering.”

Overall interest among operators in offering healthful kids’ menu items “has been building for several years now,” says Mike Donohue, an NRA spokesman. Restaurateurs “are looking to help parents make the best decisions for their families.”

About two-thirds of American quick-service-restaurant operators offer more healthful choices than they did just two years ago, according to association statistics.

Donohue says the issue was addressed in a popular panel discussion at last year’s NRA Show and was “prominently discussed at the [association’s September] board meeting” attended by First Lady Michelle Obama, who praised the industry for steps it is taking and urged it to do even more in areas of portion size, nutrition, and marketing.

This is similar to the message increasingly emphasized by dieticians.

“I’m glad restaurants are concerned and moving in the right direction,” says Dr. Lilian Cheung, a dietician and director of health promotion and communication in the Department of Nutrition at Harvard University’s School of Public Health in Cambridge, Massachusetts. “There is a general trend to improve, but more needs to be done.”

She says eateries need to offer fruits and vegetables, whole grains in bread and pasta, smaller portions, and reduced sodium and sugar in food as part of kids’ menus.

“It is a sobering fact that children are getting diabetes in the first decade of life,” Cheung says of the fallout from the obesity problem. “Pediatricians did not see this 10 years ago. And the trajectory is not rosy if we don’t turn it around.”

But operators can’t make changes drastically and expect a positive long-term outcome, says Margie Saidel, vice president of nutrition and sustainability with Chartwells School Dining Services in Rye Brook, New York. The company manages dining at 550 schools.

“You have to change slowly, a few things at a time to be most successful,” Saidel says.

School-age kids want to customize their food, not with a large amount of choice but with menu items that appeal to their own likes and dislikes, she says. And if kids like something, a healthier version may be available.

She pointed to french fries and pizza as examples. Fries could be baked rather than deep-fried or they could be made using sweet potatoes rather than white. Pizza can be made to look familiar but could include whole-wheat flour and less cheese.

Just as important as the food is the advertising and marketing directed toward kids. It’s no surprise that commercials aimed at kids have been a hot topic for years, considering the susceptibility of children to advertising.

The issue became so important that the two biggest quick-service burger chains, McDonald’s and Burger King, became members of the Better Business Bureau’s Children’s Food and Beverage Advertising Initiative.

The members agree that any advertising and media marketing to children younger than 12 must promote healthful food. For restaurants, that means no more than 560 calories per meal and less than 30 percent of calories from fat, among other requirements.

Advertising a meal with fries and soda “is not going to cut it,” says Elaine Kolish, director of the initiative. “That doesn’t mean kids can’t order that once they’re in the restaurant, but they’re not in the ads.”

Of course, kids are typically finicky eaters. They may choose apples, bananas, carrots, milk, and juice, but just as easily could demand to eat something less healthy.

“You can introduce those healthier items, but unless parents are willing to enforce that change, it is hard to have that fight in the restaurant,” Mintel’s Giandelone says. “You have to be willing either to have that scene or give in for the sake of convenience.”

Nutrition is typically a battle that families face first at home, “and parents often take the path of least resistance,” says Jeff Davis, Dallas-based president of restaurant consulting firm Sandelman & Associates. “The reality is kids will eat carrots instead of french fries, but a conscious decision has to be made to make this part of a routine.”

Parents are serving healthier products to their children at home, and that “tends to be carried into restaurants,” says David Bohan, chairman of Nashville, Tennessee–based ad firm Bohan Advertising that oversees WhyMomsRule.com

Significant focus is being placed on fast feeders regarding nutrition, because they seem to have a distinct advantage in drawing families’ dining dollars. That’s thanks to their value, kids’ meal toys and games, and other family friendly offerings, such as playgrounds.

In recent years, quick-service restaurants have made an effort to add more nutritious items on kids’ menus. McDonald’s, Burger King, Subway, and others offer sliced apples; Sonic lists a banana on its menu; Wendy’s has mandarin oranges; and Chick-fil-A offers a fruit cup.

Burger King gave its fruit a bit of fun and whimsy. Its Apple Fries are apples sliced in the shape of french fries and served in a french-fry-like container. Low-fat caramel sauce is for dipping.

In July, the company also launched a kids’ breakfast meal, featuring a breakfast muffin sandwich with Apple Fries and apple juice.

One chain aligned with healthy eating is Subway, which offers a children’s menu that clocks in at less than 500 calories for a turkey, ham, roast beef, or veggie mini-sandwich (without cheese), apple slices, and milk or juice.

“We didn’t start off with a calorie count,” says Lanette Kovachi, Subway’s dietician who works with the research and development department. “We wanted to make sure the meal was balanced. The calories just fell in place with that.

“Parents themselves like to go to Subway and get a fresh, healthful meal, and it is an easier way to give your kids a better meal,” Kovachi says.

Jason’s Deli has looked at the kids’ meal as a way to build a family friendly business, particularly during the dinner daypart. At the same time, the Beaumont, Texas–based chain wanted to differentiate itself from other restaurants.

“We’re a deli with lots of meat and bread and cheese and sauerkraut and so on, but we wanted moms to feel good about bringing their kids here,” says Pat Herring, director of research and development. “That’s how we developed our kids’ menu.”

When the company decided to remove partially hydrogenated oil from the menu eight years ago, it was cut first from kids’ items. The same happened later with some preservatives and high fructose corn syrup.

“We kind of feel that kids are defenseless, so this gives them a better opportunity to eat healthfully,” Herring says.

The chain’s more than 200 restaurants offer varied kids’ meals with entrées such as an organic peanut butter and jelly sandwich, turkey and cheese sandwich on wheat bread or organic wheat wrap, nitrite-free ham and cheese sandwich, and a salad bar.

The meals, which range from $2.59 to $3.59, include a side of organic apples, organic carrots, fresh fruit or chips, and a drink of organic white or chocolate milk, organic apple juice, or a fountain drink. Organic may be more expensive, Herring says, but parents appreciate it.

Another trend in kids’ meals, according to the NRA survey, is cultural cuisine, and many Mexican, Asian, and other ethnic quick-service and fast-casual restaurants have added children-sized portions.

“Kids are getting more sophisticated in what they eat and more open to different foods,” Monnette says. “It trickles down from their parents, and it’s giving operators more leeway to do things a little differently.

During the past year, Denver-based Chipotle introduced children’s meals, including tacos or small quesadillas with a side of rice and beans. The meals, with chips and a drink, are $2.95–$3.95.

Another Denver-based chain, Garbanzo Mediterranean Grill, launched a new kids’ menu last spring. Its entrées are a grilled cheese pita, peanut butter and jelly pita, chicken or steak rice bowl, and a half pita stuffed with falafel, chicken, steak, or a combination falafel with marinated chicken or steak.

The $3.99 meal includes seasoned rice, apple slices or chips, and white or chocolate milk or a soft drink. The calorie count ranges from 150 to 540.

“This was a nice twist on familiar kids favorites with some Mediterranean injected in it,” says Melissa Rogner, assistant director of marketing for the 12-store chain. “We may add other items to the kids’ menu later, but we want to continue to get the taste buds of the younger people acclimated to this type of cuisine.”

Even with all the healthful additions to children’s menus, operators need to continue to focus on price and value, experts say.

“Price is still a primary driver,” says Bohan, referring to the WhyMomsRule.com survey, which found that 63 percent of the moms are choosing items from the value menu and six of 10 are seeking restaurant coupons or discounts.

There are few “kids eat free” deals at quick-service and fast-casual eateries, analysts say, because the prices already are largely at a value level. A few, however, such as Quiznos and Qdoba Mexican Grill, used it for a limited time during the past year.